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KJO Korean Journal of Orthodontics

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pISSN 2234-7518
eISSN 2005-372X

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    • Review Article l 2024-07-25

      Intraoral ageing of aligners and attachments: Adverse effects on clinical efficiency and release of biologically-active compounds

      Theodore Eliades , George Eliades

      Abstract : The clinical application of aligners is accompanied by the ageing of the polymer appliances and the attachments used, which may result in inefficiency in reaching the predicted range of tooth movement, and release of compounds and microplastics in the oral cavity as a result of the friction, wear and attrition of the aligner and composite attachment. The purpose of this review is to present the mechanism and effects of in vivo ageing; describe the hydrolytic degradation of aligners and enzymatic degradation of composite attachments; examine the ageing pattern of aligners in vivo, under actual clinical scenarios; and identify a link to the discrepancy between predicted and actual clinical outcome. Lastly, strategies to deal with three potentially critical issues associated with the use of aligners, namely the necessity of weekly renewal, the dissimilar mechanical properties of aligner and attachment resulting in wear and plastic deformation of the aligner, and the development of integuments and biofilms with microbial colonization of the appliance, are discussed.

      Abstract  
    • Original Article l 2023-05-25

      Covariance patterns between ramus morphology and the rest of the face: A geometric morphometric study

      Marietta Krüsi , Demetrios J. Halazonetis, Theodore Eliades, Vasiliki Koretsi

      Abstract : Objective: The growth and development of the mandible strongly depend on modeling changes occurring at its ramus. Here, we investigated covariance patterns between the morphology of the ramus and the rest of the face. Methods: Lateral cephalograms of 159 adults (55 males and 104 females) with no history of orthodontic treatment were collected. Geometric morphometrics with sliding semi-landmarks was used. The covariance between the ramus and face was investigated using a two-block partial least squares analysis (PLS). Sexual dimorphism and allometry were also assessed. Results: Differences in the divergence of the face and anteroposterior relationship of the jaws accounted for 24.1% and 21.6% of shape variation in the sample, respectively. Shape variation was greater in the sagittal plane for males than for females (30.7% vs. 17.4%), whereas variation in the vertical plane was similar for both sexes (23.7% for males and 25.4% for females). Size-related allometric differences between the sexes accounted for the shape variation to a maximum of 6% regarding the face. Regarding the covariation between the shapes of the ramus and the rest of the face, wider and shorter rami were associated with a decreased lower anterior facial height as well as a prognathic mandible and maxilla (PLS 1, 45.5% of the covariance). Additionally, a more posteriorly inclined ramus in the lower region was correlated with a Class II pattern and flat mandibular plane. Conclusions: The width, height, and inclination of the ramus were correlated with facial shape changes in the vertical and sagittal planes.

    • Original Article l 2023-07-25

      Pattern of lip retraction according to the presence of lip incompetence in patients with Class II malocclusion

      Mei Ling Fang , Sung-Hwan Choi, Yoon Jeong Choi, Kee-Joon Lee

      Abstract : Objective: The aim of this retrospective study was to compare changes in hard tissue and soft tissue after the four first premolars were extracted with anterior teeth retraction according to the presence or absence of lip incompetence. Methods: Patients who underwent the four first premolars were extracted with anterior teeth retraction were divided into competent (n = 20) and incompetent lip (n = 20) groups. Cephalometric measurements for hard tissue and soft tissue changes were performed pre-treatment and post-treatment. Results: In the competent group, the upper and lower lips retreated by 2.88 mm and 4.28 mm, respectively, and in the incompetent group by 4.13 mm and 5.57 mm, respectively; the differences between the two groups were significant (p < 0.05). A strong positive correlation between retraction of the upper lip and upper incisors was observed in both groups (p < 0.05), whereas a correlation between retraction of the lower lip and lower incisors was only found in the incompetent group. A simple linear regression analysis showed that the pattern of lip retraction following the retraction of the anterior teeth was more predictable in the incompetent group than in the competent group. Conclusions: These findings suggest that the initial evaluation of lip incompetence in patients with skeletal Class II is essential for the accurate prediction of the soft tissue changes following retraction of the anterior teeth in premolar extraction treatment. Therefore, sufficient explanation should be provided during patient consultations.

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    • Original Article l 2023-09-25

      Effect of 125 Hz and 150 Hz vibrational frequency electric toothbrushes on the rate of orthodontic tooth movement and prostaglandin E2 levels

      Anadha N. Gujar , Prashantha Govinakovi Shivamurthy

      Abstract : Objective: To evaluate the effects of an electric toothbrush with vibrational frequencies of 125 Hz and 150 Hz on the orthodontic tooth movement (OTM) rate and the production of prostaglandin E2 (PGE2). Methods: Out of thirty patients (aged 18–25 years; 16 females and 14 males), ten patients each formed Group A and B, who used electric toothbrushes with 125 Hz and 150 Hz vibrations, respectively. The remaining ten patients (Group C) served as the control group and did not use electric toothbrushes. The rate of OTM and levels of PGE2 using microcapillary pipettes were calculated before the start of retraction (T0), on the 30th day (T1), on the 60th day (T2), and on the 90th day (T3) from the start of retraction in all the groups. Results: There was a statistically significant difference in the mean OTM values and PGE2 levels in all three groups at different time intervals, with the maximum difference seen in Group B compared to Group A and least in Group C at T1, T2 and T3. Conclusions: The rate of OTM and levels of PGE2 were highest in patients who used an electric toothbrush with 150 Hz mechanical vibration compared to those who used an electric toothbrush with 125 Hz mechanical vibration and least in patients who did not use an electric toothbrush. Mechanical vibration led to an increase in the PGE2 levels and accelerated the OTM.

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    • Original Article l 2024-03-25

      Evaluating anchorage loss in upper incisors during distalization of maxillary posterior teeth using clear aligners in adult patients: A prospective randomized study

      Zehra Yurdakul , Nurver Karsli

      Abstract : Objective: To evaluate the effect of clear aligner treatment and differential sequence distalization of maxillary posterior teeth on anchorage loss in the upper incisors (U1s). Methods: This study used lateral cephalometries and digital models of 12 patients treated with 33% sequential distalization (group 1, mean age: 22.9 ± 0.7 years, five males, seven females) and 12 treated with 50% sequential distalization (group 2, mean age: 25.83 ± 0.5 years, three males, nine females) acquired before and after distalization of upper second premolars (U5) and upper first molars (U6) and upper second molars (U7). The amount of distalization was determined as 2.5 mm in both the groups. Independent Samples t test was used to compare normally distributed parameters. Mann–Whitney U and Wilcoxon tests were used to compare parameters that were not normally distributed. Results: In both groups, the posterior teeth significantly moved by tipping distally and the U1s were displaced anteriorly. Increase in maxillary posterior transverse width (P < 0.001) and distopalatal rotation were observed in U5, U6, and U7 after distalization. It was also observed that U1 was significantly more proclined (1.82°; P < 0.001) and protruded (0.62 mm; P < 0.001), and the overjet (0.45 mm; P < 0.001) increased more in group 1 than in group 2. Conclusions: After sequential distalization of maxillary posterior teeth, more anchorage loss was observed in the anterior region in group 1 than in group 2.

      Abstract  
    • Original Article l 2023-01-25

      Evaluation of the cell viability and antimicrobial effects of orthodontic bands coated with silver or zinc oxide nanoparticles: An in vitro study

      Rashin Bahrami , Maryam Pourhajibagher, Alireza Badiei, Reza Masaeli, Behrad Tanbakuchi

      Abstract : Objective: We aimed to evaluate the cell viability and antimicrobial effects of orthodontic bands coated with silver or zinc oxide nanoparticles (nano-Ag and nano-ZnO, respectively). Methods: In this experimental study, 30 orthodontic bands were divided into three groups (n = 10 each): control (uncoated band), Ag (silver-coated band), and ZnO (zinc oxide-coated band). The electrostatic spray-assisted vapor deposition method was used to coat orthodontic bands with nano-Ag or nano-ZnO. The biofilm inhibition test was used to assess the antimicrobial effectiveness of nano-Ag and nano-ZnO against Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans. Biocompatibility tests were conducted using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay. The groups were compared using oneway analysis of variance with a post-hoc test. Results: The Ag group showed a significantly higher reduction in the number of L. acidophilus, C. albicans, and S. mutans colonies than the ZnO group (p = 0.015, 0.003, and 0.005, respectively). Compared with the control group, the Ag group showed a 2-log10 reduction in all the microorganisms' replication ability, but only S. mutants showed a 2-log10 reduction in replication ability in the ZnO group. The lowest mean cell viability was observed in the Ag group, but the difference between the groups was insignificant (p > 0.05). Conclusions: Coating orthodontic bands with nano-ZnO or nano-Ag induced antimicrobial effects against oral pathogens. Among the nanoparticles, nano-Ag showed the best antimicrobial activity and nano-ZnO showed the highest biocompatibility.

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    • Original Article l 2023-03-25

      Thermo-mechanical properties in bending of a multizone nickel-titanium archwire: A retrieval analysis

      Panagiotis Roulias , Ioulia-Maria Mylonopoulou, Iosif Sifakakis , Christoph Bourauel, Theodore Eliades

      Abstract : Objective: This study aimed to compare the mechanical and thermal properties in the anterior and posterior segments of new and retrieved specimens of a commercially available multizone superelastic nickel-titanium (NiTi) archwire. Methods: The following groups of 0.016 × 0.022-inch Bioforce NiTi archwires were compared: a) anterior and b) posterior segments of new specimens and c) anterior and d) posterior segments of retrieved specimens. Six specimens were evaluated in each group, by three-point bending and bend and free recovery tests. Bending moduli (Eb) were calculated. Furthermore, the new specimens were evaluated with scanning electron microscopy/energy-dispersive X-ray spectrometry. A multiple linear regression model with a random intercept at the wire level was applied for data analysis. Results: The forces in the posterior segments or new specimens were higher than those recorded in the anterior segments or retrieved specimens, respectively. Accordingly, Eb also varied. Higher austenite start and austenite finish (Af) temperatures were recorded in the anterior segments. No statistically significant differences were found for these temperatures between retrieved and new wires. The mean elemental composition was (weight percentage): Ni, 52.6 ± 0.5; Ti, 47.4 ± 0.5. Conclusions: The existence of multiple force zones was confirmed in new and retrieved Bioforce archwires. The retrieved archwires demonstrated lower forces during the initial stages of deactivation in three-point bending tests, compared with new specimens. The Af temperature of these archwires may lie higher than the regular intraoral temperature. Even at 2 mm deflections, the forces recorded from these archwires may lie beyond biologically safe limits.

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    • Original Article l 2023-05-25

      Perception of discrepancy in the upper midline position in conjunction with the gingival display according to various occupations in Iran

      Hooman Zarif Najafi , Taraneh Estedlal, Maryam Saki , Maryam Azadi

      Abstract : Objective: This study evaluated the influence of various gingival displays on the esthetic perception in the presence of upper dental midline discrepancy. Methods: A smiling image of a male subject was altered digitally to produce five image series: normal smile (series A), decreased tooth show (series B), increased gingival show (series C), maxillary cant (series D), and asymmetric upper lip elevation (series E). In each image series, the midline was deviated to the right and left incrementally. A total of 210 raters (four professional groups and laypersons, n = 42 in each group) determined the midline deviation threshold and the attractiveness of midline position in each series. Results: The right and left thresholds were statistically similar for the symmetrical series (A, B, and C), while for series D, the right threshold was significantly lower. In most rater groups, the mean threshold order was: B > A > E > C > D. In all the series, the raters selected the coincident midline as the most attractive series except for series D, for which 1–2-mm deviations to the left were selected as the most attractive by almost all the groups. Conclusions: It is crucial to establish the coincident midline position in a symmetrical smile, especially when a gummy smile exists. In the asymmetrical gingival show, a coincident midline might not be the most esthetic midline position.

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    • Original Article l 2023-09-25

      Three-dimensional evaluation of the association between tongue position and upper airway morphology in adults: A cross-sectional study

      Yuchen Zheng , Hussein Aljawad, Min-Seok Kim, Su-Hoon Choi, Min-Soo Kim, Min-Hee Oh, Jin-Hyoung Cho

      Abstract : Objective: This study aimed to evaluate the association between low tongue position (LTP) and the volume and dimensions of the nasopharyngeal, retropalatal, retroglossal, and hypopharyngeal segments of the upper airway. Methods: A total of 194 subjects, including 91 males and 103 females were divided into a resting tongue position (RTP) group and a LTP group according to their tongue position. Subjects in the LTP group were divided into four subgroups (Q1, Q2, Q3, and Q4) according to the intraoral space volume. The 3D slicer software was used to measure the volume and minimum and average cross-sectional areas of each group. Airway differences between the RTP and LTP groups were analyzed to explore the association between tongue position and the upper airway. Results: No significant differences were found in the airway dimensions between the RTP and LTP groups. For both retropalatal and retroglossal segments, the volume and average cross-sectional area were significantly greater in the patients with extremely low tongue position. Regression analysis showed that the retroglossal airway dimensions were positively correlated with the intraoral space volume and negatively correlated with A point-nasion-B point and palatal plane to mandibular plane. Males generally had larger retroglossal and hypopharyngeal airways than females. Conclusions: Tongue position did not significantly influence upper airway volume or dimensions, except in the extremely LTP subgroup.

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    • Original Article l 2023-11-25

      Differences in facial soft tissue deviations in Class III patients with different types of mandibular asymmetry: A cone-beam computed tomography study

      Ho-Jin Kim , Hyung-Kyu Noh, Hyo-Sang Park

      Abstract : Objective: This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients. Methods: Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey’s post-hoc test was performed for intergroup comparisons. Pearson’s correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations. Results: The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01). Conclusions: The three-dimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

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November, 2024
Vol.54 No.6

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Clinical Journal of Korean Association of Orthodontists